Provider Demographics
NPI:1437266020
Name:PARKS, ROBERTA R (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:R
Last Name:PARKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 WASHINGTON ST
Mailing Address - Street 2:SUITE 219
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-4634
Mailing Address - Country:US
Mailing Address - Phone:617-426-5500
Mailing Address - Fax:
Practice Address - Street 1:294 WASHINGTON ST
Practice Address - Street 2:SUITE 219
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-4634
Practice Address - Country:US
Practice Address - Phone:617-426-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77637208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist